consequences of chronic cough Flashcards

1
Q

What are the pulmonary consequences of chronic cough

A

Dynamic airway compression in asthma

  • expiration is difficults
  • so build up of air trapped in alveoli can lead to rupture of visceral pleura
  • air enters the pleural cavity and cause a penumothroax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a small pneumothorax and what happens

A
  • less than 2 cm

Air enters the pleural cavity from:

  1. Penetrating injury to parietal pleura
  2. Rupture of visceral pleura

The Transmural pressure gradient is lost and long recoils towards the lung root and small pneumothorax results

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a large pneumonthorax and what happens

A
  • More than 2cm (between pareital and visceral pleura)

can occur due to:

  1. Penetrating injury to parietal pleura
  2. Rupture of visceral pleura
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is Pneumothorax Diagnosed

A
  • History
  • Examination
  • > Reduced breath sounds ipsilaterally
  • > Reduced ipsilateral chest expansion

-> Hypersonnace on percussion

  • Investigation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How to spot a pneumothrax on a CXR

A
  • Abscent lung markings peripherally (opaque lines and blood vessels)
  • Lung edge is visible
  • tracheal shift
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a Tension pneumothorax

A
  • one way valve created which permits air entry into pleural cavit on inspiration but cannot exit on expiration
  • Intra-pleural pressure is increased with each inspiration
  • Collapse on lung towards its root
  • Eventaully shift in mediastinal structures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are 4 divisions of the mediastinum

A
  • Superior - T4
  • Inferior - divided into (T7)

- Anterior

- Middle

- Posteiror

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the consequences of a mediastinal shift

A
  1. Tracheal deviation -​ unilateral pneumothorax
  2. Superior vena cava compression

​ - Reduced Venous return to the heart

- Low arterial blood pressure

- Hypoxia, chest pain and dyspnoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the Managment of a large pneumothorax

A
  1. Needle aspiration - 2-3rd intercostal space midclavicular line
  2. ​Chest Drain

the 4th and 5th intercostal space in the midaxillary line - the safe Triangle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the Safe Triangle

A
  • Anterior border of lassimus dorsi
  • Posteiror border of pectoralis major
  • axial line superior to the nipple

entry into the middle of intercostal spaces due to NVB bundle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Whay is the emergency managment of a Tension penumothroax

A
  • level of rib 2 = sternal anlge
  • Midclavicular line
  • Guage cannula inserted into pleural cavity via the 2nd and 3rd intercostal spaces

Cannula passes through:

  • superficial fascia
  • Deep fascia
  • 3 layers of intercostal muscles
  • Parietal pleura
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Other consequences of chronic cough = Herniae

A

Two factors lead to development

  1. Weakness of one structure - commonly part of body wall
  2. Increased pressure on one side of that part of the body wall - due to chronic cough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Herniaes occuring from weekness in one structure

A

Normal anatomical weakness

  • Diaphragm - diaphragmatic herniae
  • Umbillicus - umbilical hernia
  • Inguinal canal - inguinal hernia
  • femoral canal- femoral hernia

Congenital abnormalities

  • congenital Diaphragmatic hernia

Surgical scars weakness

  • incisional hernia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where do Diaphragmatic Hernias Develop

A
  • Aortic Hiatus - level of T12
  • Normal anatomical weekness at attachments to the xiphoid process
  • Inferior Vena Cava -IVC canal opening - T8
  • Oesophageal Hiatus - T10
  • Normal anatomical weekness posteiror attachments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a paraoesophageal Histus Hernia

A
  • Herniated part of the stomach passes through the oesophageal hiatus to become parallel to the Oesophagus and the chest
  • Pocket sticks out parallel to the oesophagus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the Sliding hiatus Hernia

A
  • The herniated part of the stomach slides through the oesopaheal hiatus into the chest with the gastro-oesophageal junction
17
Q

Where is the inguinal region

A

Between the anterior superior illiac spine and the pubic tubercle

18
Q

What are the inguinal ligaments

A
  • connective tissue ligaments
  • attach between the anteiror superior illiac spine and the pubic symphysis
  • Their medial halves form the floor of the inguinal canal

inferior borders of the external oblique aponeurosis

19
Q

What are the inguinal canals

A
  • 4 cm long passage ways through anterior abdominal wall in the inguinal regions
  • medial half of the inguinal liganments
  • Deep ring (entry)
  • superficial ring (exit)
20
Q

where is the deep ring of the inguinal canal located

A
  • superior to the midpoint of the inguinal ligament
21
Q

Where is the superficial ring of the inguinal canal located

A
  • V- shaped defect in the external oblique aponeurosis
  • lies superiolateral to the pubic sympysis
22
Q

What are inguinal Herniae

A
  • they form in the medial half of the inguinal region

form due to:

  1. Weekness in inguinal canal - the canal forms during development and allows passage of the testes in males and passage of round ligament of uterus in female
  2. increased intra-abdominal pressure- chronic cough, chronic constipation, lifting heavy wieghts and athletic effort
23
Q

Layers of the anteriolateral abdominal wall

A
  • skin
  • superficial fascia
  • Deep fascia
  • inguinal ligament
  • internal oblique
  • Tranverse Abdominis
  • Transverse fascia
  • parietal peritoneum
  • Visceral peritoneum
  • Testicular vein
  • Testicular artery
24
Q

How do the testes develope

A

Trans-abdominal phase

  • A band of connective tissue known as the gubernaculum connects testis to the scortum
  • The Gubernaculum drags the testis into the deep inguinal ring

Trans-inguinal Phase

  • Process vaginalis (outpouching of the pariental peritonuem)
  • pushes its way through tissue of developing abdonimal wall
  • follows the course of the Gubernaculum
25
Q

What tissues form the abdomincal wall become part of the psermatic cord

A
  • Transverse falis fascia
  • internal obliue
  • External oblique

Becomes:

  • Internal spermatic fascia
  • Cremasteric fascia
  • External spermatic fascia

The distal tip of the process vaginalis becomes the tunica vaginalis

26
Q

What are the complete contents of the spermatic cord

A
  • Vas deferens
  • testicualr artery
  • paminiform plexus of veins
  • automonic nerves
  • genetofemoral nerve
  • lymathetics
27
Q

What does the illioinguinal nerve inervate

A

anteiror surface of scortum

branches from L1

28
Q

the female inguinal canal

A

females also have inguinal regions, inguinal ligaments, inguinal canals, deep inguinal rings, superficial inguinal rings and can develop an inguinal hernia (less commonly)

29
Q

How do ovaries develop

A
  • in the abdominal wall
  • Round ligaments passes through inguinal canal into the labium majus
  • these are the fibrous embryological remenants in adult female
30
Q

What is a direct inguinal herniea

A

a ‘finger’ of peritoneum is forced through posterior wall of the inguinal canal and directly out of the superficial ring into the scortum

31
Q

What is an indirect herniea

A

a ‘finger’ of peritoneum is first forced through the deep ring into inguinal canal and then out of superficial ring into the scortum

32
Q

How to clinically differentiate between a direct and indirect herniea

A
  • Reduce hernia (200 feet up)
  • Occulfe the deep ring with finger tip pressure
  • ask patient to cough

If its direct - lump will appear

if its indirect - lump will not appear